Introduction
Methodology
Category, grade | Definition |
---|---|
Strength of recommendation | |
A | Good evidence to support a recommendation for use |
B | Moderate evidence to support a recommendation for use |
C | Poor evidence to support a recommendation |
D | Moderate evidence to support a recommendation against use |
E | Good evidence to support a recommendation against use |
Quality of evidence | |
I | Evidence from ≥1 properly randomized, controlled trial |
II | Evidence from ≥1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from >1 center); from multiple time series; or from dramatic results from uncontrolled experiments |
III | Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees |
Pathology and molecular diagnosis
Subtype | CK-7 | CK-20 | WT-1 | P53 | RE | RP | B-catenina | Other/comments |
---|---|---|---|---|---|---|---|---|
High grade serous | + | − | + | + | ± | ± | BRCA germline-mutated (20 %) Transitional is classified as high-grad e serous with transitional features | |
Mucinous | + | ± | ∓ | − | − | CDX2 variable PAX8 (50 %)+ | ||
Endometrioid | + | − | ∓ | ∓ | ± | ± | +(40–50 %) | |
Clear cell | + | − | − | − | − | |||
Low-grade serous | + | − | + | ± | ± | MD Anderson two-tier grading system required |
Surgical treatment
Early disease (clinical stage I/II)
Advanced disease (III–IV)
Systemic therapy in first line
Early stages
Advanced stages
Conventional chemotherapy
Neoadjuvant chemotherapy (NAC)
Dose-dense regimen
Intraperitoneal chemotherapy (IP CT)
Study | Control regimen | Experimental regimen | Eligible patients | No. of patients | PFS IV/IP | OS IV/IP |
---|---|---|---|---|---|---|
SWOG 8501/GOG 104, Alberts et al. [13] | Cisplatin, 100 mg/m2 i.v.; cyclophosphamide, 600 mg/m2 i.v.; q 3 weeks × 6 | Cisplatin, 100 mg/m2 i.p.; cyclophosphamide, 600 mg/m2 i.v.; q 3 weeks × 6 | Stage III, ≤2 cm residual | 546 | – | 41 |
– | 49 | |||||
P = 0.02 | ||||||
GOG 114/SWOG 9227, Markman et al. [14] | Cisplatin, 75 mg/m2 i.v.; paclitaxel, 135 mg/m2 24-h i.v.; q 3 weeks × 6 | Carboplatin, AUC 9 i.v.; q 28 days × 2; cisplatin, 100 mg/m2 i.p.; paclitaxel, 135 mg/m2 24-h i.v.; q 3 weeks × 6 | Stage III, ≤1 cm residual | 462 | 22.5 | 52.5 |
27.6 | 63.2 | |||||
P = 0.01 |
P = 0.05 | |||||
GOG 172, Armstrong et al. [15] | Cisplatin, 75 mg/m2 i.v.; paclitaxel, 135 mg/m2 24-h i.v.; q 3 weeks × 6 | Paclitaxel, 135 mg/m2 24-h i.v.; Cisplatin, 100 mg/m2 i.p.; paclitaxel, 60 mg/m2 i.p. on day 8; q 3 weeks × 6 | Stage III, ≤1 cm residual | 415 | 18.3 | 49.5 |
23.8 | 66.9 | |||||
P = 0.05 |
P = 0.03 |
Antiangiogenic therapy
Therapy for relapsed ovarian cancer
-
Progression while receiving last line of platinum-based therapy or within 4 weeks of last platinum dose.
-
Progression-free interval since last line of platinum of <6 months.
-
Progression-free interval since last line of platinum of 6–12 months.
-
Progression-free interval since last line of platinum of >12 months.
Treatment of distinct subgroups defined by progression-free interval
Treatment of patients with a PFI <6 months
Treatment of patients with a PFI >12 months
Study |
N
| Prior | 6–12 Months* (%) | Treatment | PFS (m) | HR | 95 % CI | OS |
---|---|---|---|---|---|---|---|---|
Taxane (%) | ||||||||
ICON 4 [21] | 802 | 43 | 25 | Carboplatin | 9 | 0.76 | 0.66–0.89 | 24 m |
Carboplatin-Pac | 12 | 29 m* | ||||||
GEICO 9801 [22] | 81 | 87 | 42 | Carboplatin | 8.4 | 0.54 | 0.32–0.92 | 17 m |
Carboplatin-Pac | 12.2 | – | ||||||
AGO-EORTC [23] | 356 | 70 | 40 | Carboplatin | 5.8 | 0.72 | 0.58–0.90 | 17.3 m* |
Carboplatin-Gem | 8.6 | 18 m | ||||||
CALYPSO [24] | 973 | 35 | 99 | Carboplatin-Pac | 9.4 | 0.821 | 0.72–0.94 | 33 m |
Carboplatin-PLD | 11.3 | 30.7 m | ||||||
OCEANS [25] | 484 | 100 | 42 | Carboplatin-gemcitabine | 8.4 | 0.48 | 0.38–0.60 | 35.2 |
Carboplatin-gemcitabine-bevacizumab | 12.4 | 33.3 |